Perspectives on Thoracic Endovascular Aortic Repair for Uncomplicated Type B Aortic Dissection: An International Survey Within the SUNDAY Network
13 affiliations
- 1Department of Vascular Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- 2Department of Vascular Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- 3Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
- 4Department of Vascular Surgery, Erasmus Medical Center, Molenwaterplein 40, 3015 GB Rotterdam, The Netherlands
- 5Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- 6Department of Vascular Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- 7Department of Vascular Surgery, University Medical Center Utrecht, Hiedelberglaan 100, 3584 CX Utrecht, The Netherlands
- 8Department of Surgical Sciences, Uppsala University, Sjukhusvägen 70, 751 85 Uppsala, Sweden
- 9Department of Vascular Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- 10Faculty of Health Sciences, Copenhagen University, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- 11Department of Vascular Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- 12Department of Atherosclerosis & Aortic Diseases, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- 13³ Department of Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
Abstract
Background: Thoracic endovascular aortic repair (TEVAR) is increasingly considered in selected patients with uncomplicated type B aortic dissection (uTBAD), but uncertainty remains regarding indications for intervention and treatment strategies. This study aimed to explore potential variation in TEVAR indications and treatment strategies for uTBAD among principal investigators (PIs) of the Scandinavian trial of Uncomplicated Aortic Dissection Therapy (SUNDAY). Methods: A prospective, cross-sectional, questionnaire-based study was conducted among PIs of the SUNDAY trial network. A structured survey was developed by the first and last author using contemporary guidelines and relevant literature and was subsequently reviewed by all co-authors. The questionnaire addressed three topics: definitions, TEVAR indications, and treatment strategies. Data were collected via Castor and analyzed using SPSS version 29.0. A center-weighted sensitivity analysis and within-center concordance analysis were performed to account for multiple respondents from the same center. Results: The response rate was 78.2% (43/55 PIs), representing 31 centers. The presence or development of complications was the main driver for TEVAR (37/43, 86.0%). Rupture (43/43, 100%), clinical signs of malperfusion (43/43, 100%), and rapid aortic expansion (38/43, 88.4%) were consistently considered indications for TEVAR, whereas more variation was observed for refractory pain (28/43, 65.1%) and refractory hypertension (26/43, 60.5%). Interpretation of high-risk imaging features varied, with 37.2% (16/43) considering multiple features an indication for TEVAR. Procedural strategies varied, with spot stenting selected by 58.1% (25/43) of respondents, although more extensive aortic coverage was also reported. Landing zone characteristics and oversizing preferences were more consistent, with 79.1% (34/43) defining a healthy landing zone by the absence of intramural hematoma or dissection, 58.1% (25/43) preferring a landing zone length of 2 cm, and 51.2% (22/43) preferring 10% stent graft oversizing. Center-weighted sensitivity analyses showed generally similar estimates, whereas within-center concordance varied across items (range 20–100%), with complete agreement for 8 of 50 items. Conclusions: Among SUNDAY PIs, there was broad agreement regarding the distinction between uncomplicated and complicated type B aortic dissection (TBAD) and the role of TEVAR in the presence of complications, whereas variation remained in the interpretation of high-risk imaging features and procedural strategies. These findings highlight variation in decision-making regarding the management of uTBAD within the SUNDAY network and support the need for prospective evidence to guide TEVAR decision-making.
Related
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BibTeX
@article{biersteker2026perspectives,
title = {{Perspectives on Thoracic Endovascular Aortic Repair for Uncomplicated Type B Aortic Dissection: An International Survey Within the SUNDAY Network}},
author = {Bianca Biersteker and Felix Hers and Meike Langenhuijzen and Jorg Lucas de Bruin and Jean-Paul Petrus Maria de Vries and Mark Dirven and Martin Teraa and Kevin Mani and Timothy Andrew Resch and Barend Mathijs Eduard Mees and Kak Khee Yeung and Jacob Budtz-Lilly and Joost Renier van der Vorst},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197604},
url = {https://europepmc.org/article/PMC/PMC13666122},
note = {CC BY},
}
RIS
TY - JOUR
TI - Perspectives on Thoracic Endovascular Aortic Repair for Uncomplicated Type B Aortic Dissection: An International Survey Within the SUNDAY Network
AU - Bianca Biersteker
AU - Felix Hers
AU - Meike Langenhuijzen
AU - Jorg Lucas de Bruin
AU - Jean-Paul Petrus Maria de Vries
AU - Mark Dirven
AU - Martin Teraa
AU - Kevin Mani
AU - Timothy Andrew Resch
AU - Barend Mathijs Eduard Mees
AU - Kak Khee Yeung
AU - Jacob Budtz-Lilly
AU - Joost Renier van der Vorst
PY - 2026
DA - 2026/09/30
JO - Journal of clinical medicine
DO - 10.3390/jcm15197604
UR - https://europepmc.org/article/PMC/PMC13666122
AB - Background: Thoracic endovascular aortic repair (TEVAR) is increasingly considered in selected patients with uncomplicated type B aortic dissection (uTBAD), but uncertainty remains regarding indications for intervention and treatment strategies. This study aimed to explore potential variation in TEVAR indications and treatment strategies for uTBAD among principal investigators (PIs) of the Scandinavian trial of Uncomplicated Aortic Dissection Therapy (SUNDAY). Methods: A prospective, cross-sectional, questionnaire-based study was conducted among PIs of the SUNDAY trial network. A structured survey was developed by the first and last author using contemporary guidelines and relevant literature and was subsequently reviewed by all co-authors. The questionnaire addressed three topics: definitions, TEVAR indications, and treatment strategies. Data were collected via Castor and analyzed using SPSS version 29.0. A center-weighted sensitivity analysis and within-center concordance analysis were performed to account for multiple respondents from the same center. Results: The response rate was 78.2% (43/55 PIs), representing 31 centers. The presence or development of complications was the main driver for TEVAR (37/43, 86.0%). Rupture (43/43, 100%), clinical signs of malperfusion (43/43, 100%), and rapid aortic expansion (38/43, 88.4%) were consistently considered indications for TEVAR, whereas more variation was observed for refractory pain (28/43, 65.1%) and refractory hypertension (26/43, 60.5%). Interpretation of high-risk imaging features varied, with 37.2% (16/43) considering multiple features an indication for TEVAR. Procedural strategies varied, with spot stenting selected by 58.1% (25/43) of respondents, although more extensive aortic coverage was also reported. Landing zone characteristics and oversizing preferences were more consistent, with 79.1% (34/43) defining a healthy landing zone by the absence of intramural hematoma or dissection, 58.1% (25/43) preferring a landing zone length of 2 cm, and 51.2% (22/43) preferring 10% stent graft oversizing. Center-weighted sensitivity analyses showed generally similar estimates, whereas within-center concordance varied across items (range 20–100%), with complete agreement for 8 of 50 items. Conclusions: Among SUNDAY PIs, there was broad agreement regarding the distinction between uncomplicated and complicated type B aortic dissection (TBAD) and the role of TEVAR in the presence of complications, whereas variation remained in the interpretation of high-risk imaging features and procedural strategies. These findings highlight variation in decision-making regarding the management of uTBAD within the SUNDAY network and support the need for prospective evidence to guide TEVAR decision-making.
SN - 2077-0383
ER -